Lest there be an Indian Luigi Mangione
This tragic event is emblematic of the deep-rooted problems in a system that often denies care to vulnerable populations, leading to a buildup of resentment towards doctors and healthcare executives.
NEW DELHI: The recent assassination of United Healthcare CEO Brian Thompson in New York and the popular lionisation of his alleged killer Luigi Mangione has highlighted some profound issues within the American healthcare system. The incident reflects a growing sentiment against the healthcare industry in general and insurers in particular for prioritizing profits over patient care. This tragic event is emblematic of the deep-rooted problems in a system that often denies care to vulnerable populations, leading to a buildup of resentment towards doctors and healthcare executives.
India is currently on the cusp of adopting an American-style healthcare model. The country is hurtling towards a privatized and entirely profit-driven system that threatens to leave the poor and much of the middle class entirely out of its ambit. There is a danger that access to care will become contingent on financial capability, mirroring the inequities seen in the US system. That would be disastrous. India just cannot afford to have a healthcare system that its people cannot afford.
The main pillar of the American model is profit-driven Insurance. Health insurance companies have come to wield enormous power, often dictating the terms of care and coverage. This is leading to practices such as intrusive diagnostics monitoring and prior authorisation denial. It’s a system that limits doctor discretion and serves exorbitant medical bills upon patents. However, despite spending more on healthcare than any other nation, the US consistently ranks poorly on health outcomes compared to peer nations.
India is fast headed that way. The state has all but departed from the specialised care space at a time when lifestyle disease incidence is soaring. As of 2021, around 70 percent of healthcare services are being provided by private entities. Private hospitals accounted for approximately 60 percent of total hospital beds in 2022. The shift towards private diagnostics is now complete, resulting in inflated costs for even the poorest patients. With the power of insurance companies growing, they are likely to seek greater access to patient data and, going forward, a greater say in treatment and billing matters.
Privatisation of healthcare is a hurtling train in India. In just the past seven years, there has been an invasion of private equity firms buying majority stakes in super-speciality hospitals across India. In 2023 alone, PE investments in Indian healthcare reached approximately 4 billion dollars. While this influx of capital is aimed at expanding hospital networks and enhancing service delivery, it also brings concerns about prioritizing profit over patient care. There is also a looming threat that insurers will dictate treatment options based on cost rather than patient needs, potentially leading to higher diagnostic costs and limited access to necessary care, especially for the elderly and the poor.
This is a gathering storm, and it threatens to be a perfect one. We are hemmed in by several phenomena that need an urgent policy response: an exploding lifestyle disease burden, an increasing population of older people without welfare cover, an inadequate and shrinking primary healthcare system, state medicare that is abandoning the poor, an expensive medical educational system that boosts consultancy costs, and soaring treatment costs.
Meeting this onrushing challenge will require a forward-looking policy response. To start with, we could appoint a healthcare regulator with 360-degree oversight, including over PE investment, hospitalisation costs, patient data privacy, medical ethics and insurance overreach. Without adequate regulation and oversight, there is a clear danger that India may replicate the failures seen in the US system.
